Difficulty stopping urination or loss of control of bladder or bowels.

Unexplained fever, nausea or vomiting.

A history of cancer or unexplained weight loss.

No, I am not experiencing any of the above health issues.Yes, and I have not discussed these health issues with my doctor.Yes, I have one or more of these health issues but have been cleared by my doctor to proceed with this program.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Jeremy Swartzberg,
MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

Hospital Visit

Your Hospital Medicine Physician

At the hospital, you’ll be cared for by a hospital medicine doctor, also called a hospital-based specialist (HBS) or hospitalist.

The role of the hospital medicine doctor is similar to your primary care doctor who cares for you at the clinic. Both lead and coordinate your care team. The difference is that the setting is at the hospital rather than the clinic.

Admission to the Hospital

A hospitalization can be a challenging time for you and your family. It’s often unexpected or due to a serious health problem. It can bring uncertainty about the diagnosis and possible future treatment.

Our goals are to:

Address your medical needs by providing excellent care.

Keep you informed and updated about your health.

Engage you in decisions made about your care.

Do our best to keep you comfortable.

There are a few ways you might be admitted to the hospital:

A visit to the clinic to see your primary care provider or specialist and they refer you to the hospital.

An Emergency Room (ER) visit.

A preplanned surgery or procedure.

Transfer from another hospital.

Emergency Room Care

While in the Emergency Room (ER), you may be evaluated and monitored by a hospital medicine doctor who may:

Perform a physical examination.

Ask you questions.

Review your electronic medical record.

Consult with your other doctors, if needed.

Run further tests.

Once an initial assessment is done, the doctor decides if you:

Must be admitted to the hospital.

Can safely be discharged from the hospital.

You may need further assessment in the Clinical Decision Area (CDA). The CDA is an observation unit where you’ll receive care and monitoring for up to 24 hours. From there you’ll either be discharged or admitted to the hospital.

An electronic notification about your change in health is sent to your primary care doctor when you’re seen in the ER or hospitalized.

Next Steps

The next steps are based on your response to treatment and your health needs. If you need hospital care, you’ll be admitted to one of the following areas. The location depends on the level of care needed.

Medical-surgical floor (or med/surg unit). A hospital medicine doctor usually cares for you in this area.

Cardiac telemetry monitoring unit. This area is for when you’ve had a recent heart event or active heart problem. Special machines monitor your heart.

Intensive care unit (ICU). This area is for those in critical condition who require higher levels of care and monitoring. You might receive:

Some hospitals have additional specialty units to care for specific types of health problems. Examples are:

Step down units, or a step between ICU and telemetry.

Stroke units.

Dialysis units.

Hematology and oncology units.

Health Care Documents

At admission, the hospital doctor talks about the goals of your care with you and your loved ones. During this talk, you can let us know your thoughts about different life support and resuscitation measures. This will document your choices if a more serious situation unexpectedly arises during your hospital stay.

The admitting doctor may also review your Advance Directive for Healthcare, if it’s in your medical record. This form is a legal document that states who you have chosen to make medical decisions for you if you are unable to do so. It may also document your wishes for life support or resuscitation.

A POLST form is another document that clarifies your wishes about goals of care. If you haven’t completed these forms before coming to the hospital, we may ask you to do so.

Testing

Imaging. These tests help us identify problems and monitor your progress. For example, you may have a CT scan, X-ray, MRI, or ultrasound.

Cardiac testing. You may have heart tests, such as:

An echocardiogram, which is like an ultrasound that can be done at your bedside.

A stress test to look for signs of blockage. You may either be given medicine or have it while on a treadmill.

You may have other tests to evaluate and monitor your health. Be sure to ask any questions you have about tests.

Your nurse oversees when you take medications and can answer any questions you might have about medications. Make sure you understand how to properly take medications after you go home.

Discharge Procedures

When we determine you’re medically stable, we’ll develop a discharge care plan. We may also consult with your primary care doctor. Your patient care coordinator and social worker may assist with your transition to the next phase of care.

Going home or to another facility

After your hospital stay, you may need additional care.

Home. You may be able to care for yourself at home. Or, you may need:

Home health care.

Additional hired help.

Continued care assistance.

Special equipment.

Chronic conditions management. We may refer you to one of our outpatient care programs, such as diabetes or heart health programs.

Palliative care. Some hospitals have an outpatient comfort care (palliative) program. You may need to begin or continue palliative care after your hospital stay.

Skilled-nursing facility. You may need to stay in a skilled-nursing facility to continue active treatment or rehabilitation before returning home.

Assisted living. An assisted living facility (also called board and care) offers different levels of care, such as independent living, more assistance, or medical care.

Hospice. Hospice care helps keep you comfortable and manages pain medication, assisting with ongoing care and treatment. They come to your location, in any care environment.

We’ll work with you to find the facility that meets your needs.

The discharge process

We begin to plan your discharge the day before you leave the hospital. You may be discharged at any time throughout the day, but usually in the morning. We work with you to make sure everything is in place, and:

Revisit why you were in the hospital.

Review your and your family’s understanding of your hospitalization.

Explore next steps for your care and the resources required.

Review your medications. You’ll be given a printed copy and we’ll go over how you take each medication.

Give you an information packet that explains how to continue taking care of yourself.

We also:

Send a summary of your discharge plan to your primary care doctor and specialists, if needed.

Schedule follow-up appointments and tests.

Talk with you and your family about your ongoing needs.

Once you leave the hospital, your medical care is managed by your primary care doctor and specialist. The hospital staff might also call you to see if you have any questions after discharge.

We recommend that you discuss your hospitalization with all of your doctors and clinicians after you leave the hospital.